Knowledge of sexually transmitted infections and their ability to increase the risk of infection with HIV is “alarmingly” low in rural Tanzania, according to a study published in the June edition of Sexually Transmitted Infections. The researchers found that lack of knowledge about sexually transmitted infections was associated with sexual risk-taking and being HIV-positive.
It is possible to prevent the transmission of sexually transmitted infections, including HIV. Effective treatment is also available for such infections. Earlier research has shown that adopting behaviours that reduce the risk of sexually transmitted infections, and seeking treatment when symptoms of infections occur, is related to an individual’s knowledge and understanding of the risks of, symptoms of, and availability of treatment for such infections.
The design, implementation and evaluation of effective sexually transmitted infection prevention campaigns is dependent on an understanding of the levels of knowledge about such infections in the target population.
Between 1991 and 2005 an international team of investigators observed an increase in HIV prevalence from 3% to 6% in Oria village in Kilimanjaro, Tanzania. Sexual risk behaviour and sexually transmitted infections appeared to be important factors in this doubling of prevalence.
Investigators wanted to establish types and levels of knowledge about sexually transmitted infections, and the effect of such knowledge on sexual behaviours and infection with HIV amongst individuals in this village.
A total of 1528 individuals in Oria completed a study questionnaire in 2005. This survey enquired about demographics, risky sexual behaviour, knowledge of sexually transmitted infections, including their symptoms, transmission, treatment and possible complications. Blood samples for HIV testing were also collected after pre-test counselling.
There were more women (60%) than men in the study. Although most participants (78%) reported having a primary education, only 9% had been educated at secondary level or higher.
The investigators found that knowledge of sexually transmitted infections differed significantly according to age (p = 0.042). Being knowledgeable about infections was most common in the 25 – 34 age group (46%) compared to a third of those aged 15 – 24 and 36% of individuals aged between 35 – 44.
Education was also associated with a better knowledge of sexually transmitted infections (p= 0.039). Some 53% of those with a secondary education or higher were assessed as being knowledgeable about such infections compared to 38% of individuals with a primary education and 34% of those with no education.
Most individuals (89%) reported being sexually active, and screening showed that the HIV prevalence rate was a little over 6%.
Casual sex (59%) and multiple partners (51%) were the behaviours the study sample most associated with a risk of sexually transmitted infections. The symptoms of sexually transmitted infections that were most recognised were genital ulcers (55%) and copious smelly genital discharge (47%).
As regards prevention of sexually transmitted infections, 57% were aware of abstinence, and 52% of condom use. Only 39% mentioned being faithful to one partner as an effective prevention measure. The investigators interpreted this to mean that there was a low-level of trust in partner fidelity in the study population.
There was a low level of understanding of the potential complications of untreated sexually transmitted infections, and only 22% reported knowing that this could increase the risk of infection with HIV. The investigators describe this finding as “alarming”.
A lack of knowledge about the possible complications of untreated sexually transmitted infections was associated with having two or more sex partners in the previous month, not using condoms with casual partners, and being infected with HIV.
Overall, poor knowledge of sexually transmitted infections predicted lack of condom use with casual partners and infection with HIV.
“In conclusion, knowledge of sexually transmitted infections was low in this rural area. Knowledge of…complications was lacking and appeared to be an important risk factor as it influenced practice of risky sexual behaviours and consequently HIV transmission”, write the investigators. They add, “interventions directed at improving knowledge about sexually transmitted infection complication, aspects of symptoms and prevention may prove beneficial in preventing HIV/sexually transmitted infections.”
Mmbaga E.J. et al. Sexually transmitted infections knowledge and its impact on the practice of risky sexual behaviours and HIV serostatus: results from rural Kilimanjaro, Tanzania. Sex Transm Infect 84: 224 – 26, 2008.